The prevalence of sexual abuse among adolescents in school.

Sexual abuse is a profound stressor that complicates the development and health of adolescents, yet its prevalence has been difficult to estimate among adolescents in school populations. This study explored the prevalence of both incest and nonfamily abuse in 2 cohorts of adolescents in Minnesota in the 1990s (1992: N = 77374; 1998: N = 81247). Findings indicate that sexual abuse was reported by both boys and girls and among students of all ethnic groups. Approximately 10% of adolescents reported sexual abuse in each cohort, with girls 5 times more likely to report abuse than boys. Ethnic variation was minor, with African American, Native American, and Hispanic teens slightly more likely to report abuse than White or Asian American youth. School nurses should routinely assess for a history of sexual abuse in adolescents and should be prepared to provide support and referral for abused students and their families.     

Sexual abuse, alcohol and other drug use, and suicidal behaviors in homeless adolescents.

Previous research has shown that homeless youth have high rates of suicidal ideation, sexual abuse, and abuse of alcohol and other drugs. However, little is known about how these rates differ by gender and ethnicity. Our objective was to describe patterns of sexual abuse, alcohol and other drug use, and indicators of suicidal behaviors in homeless adolescents and to determine gender and ethnic differences in these factors. We used secondary data analysis of data from surveys completed by 96 homeless youth whose average age was 17.9 years. Over 60% of the sample reported a history of sexual abuse; the majority were under the age of 12 years when they first tried alcohol, marijuana, and cocaine; 56.3% had injected drugs, and 46.9% had tried inhalants. During the past 12 months, 35.1% had seriously considered suicide and 12.3% had actually attempted suicide at least once. Significantly more Hispanics than Whites had considered suicide (chi 2 = 4.31, p = .038). A disproportionate number of Hispanics (95% of the sample) reported a history of sexual abuse. Participants with a history of sexual abuse were significantly more likely than those who did not have a history of sexual abuse to have used alcohol and/or marijuana (chi 2 = 9.93, p < .01) and to have considered suicide in the past 12 months (F = 14.93, p < .001). We found that sexual abuse history is greater in this sample than in the general population and is particularly prevalent among Hispanic/Latino subjects. As in other studies, sexual abuse was more common among females than among males. High prevalence of sexual abuse, alcohol and other drug use, and suicidal behaviors in this sample of homeless youth underscores the need to develop and test community-based interventions to improve their health status.     

A comparison of the backgrounds of first time and repeated overdose patients.

This study examines the differences between two groups of parasuicide patients: 'first-timers' (patients admitted to hospital following their first overdose) and 'repeaters' (patients admitted with an overdose who had made at least one previous suicide attempt). The two patient groups were compared for factors known to increase the risk of parasuicide as well as for the experience of self-reported past sexual abuse and for symptoms of post traumatic stress disorder (PTSD). Out of a total of 100 patients interviewed, seven (15%) of first-timers gave a history of sexual abuse and complained of an average of 0.55 symptoms of PTSD. Among repeaters, 28 (53%) gave a history of sexual abuse and complained of an average of 1.84 symptoms of PTSD. Both results were statistically significant at P < 0.001.     

Self-Reported History of Sexual Coercion and Rape Negatively Impacts Resilience to Suicide Among Women Students

A substantial literature has documented that sexual abuse relates to suicidal behaviors but relatively less is known about resilience to suicide, especially cognitive deterrents to suicide. The present study investigated the effects of a history of sexual victimization on reasons for living. Female participants (N = 138; M age = 24.4 years; SD = 7.3 years; range = 18 to 53 years; 79% Caucasian) completed the Sexual Experiences Survey (SES) and the Reasons for Living (RFL) Inventory. According to SES responses, participants were classified into 5 mutually exclusive groups: no victimization, sexual contact, sexual coercion, attempted rape, and rape. Analyses of variance showed that degree of sexual victimization had a significant effect on the RFL Total scale and 2 subscales (Survival and Coping Beliefs; Moral Objections). The general pattern was that mean RFL scores in the no victimization group were significantly higher than the mean scores in the sexual coercion and rape groups. An implication is that having a history of sexual victimization, especially sexual coercion and rape, limits one's later reasons for not committing suicide. Bolstering these modifiable deterrents to suicide should be part of suicide prevention efforts among at-risk women.     

Hopelessness as Mediator of the Link Between Reports of a History of Child Maltreatment and Suicidality in African American Women

Findings from a study comparing reports of a history of child maltreatment and hopelessness in a sample of economically, socially, and educationally disadvantaged young urban African American women suicide attempters (n = 176) and demographically similar nonattempters (n = 185) revealed higher rates of child maltreatment and hopelessness among attempters than those among their nonsuicidal counterparts. Using a mediational model involving both linear and logistic regressions, results indicated that hopelessness partially mediated the link between reports of certain forms of child maltreatment (i.e., physical/emotional abuse and emotional neglect) and suicide attempts, and hopelessness fully mediated the link between child sexual abuse and suicide attempts. Of equal importance, reports of a history of childhood maltreatment significantly predicted the presence of hopelessness in those women who later attempted suicide. These results emphasize the clinical importance of screening for hopelessness in women who report a history of childhood maltreatment and/or current or previous suicidal behavior, as well as the need to target negative views of the future in clinical interventions with African American women abused as children.     

Adolescent Suicide Risk Screening in the Emergency Department

Objectives: Many adolescents who die by suicide have never obtained mental health services. In response to this, the National Strategy for Suicide Prevention recommends screening for elevated suicide risk in emergency departments (EDs). This cross‐sectional study was designed to examine 1) the concurrent validity and utility of an adolescent suicide risk screen for use in general medical EDs and 2) the prevalence of positive screens for adolescent males and females using two different sets of screening criteria. Methods: Participants were 298 adolescents seeking pediatric or psychiatric emergency services (50% male; 83% white, 16% black or African American, 5.4% Hispanic). The inclusion criterion was age 13 to 17 years. Exclusion criteria were severe cognitive impairment, no parent or legal guardian present to provide consent, or abnormal vital signs. Parent or guardian consent and adolescent assent were obtained for 61% of consecutively eligible adolescents. Elevated risk was defined as 1) Suicidal Ideation Questionnaire‐Junior [SIQ‐JR] score of ≥31 or suicide attempt in the past 3 months or 2) alcohol abuse plus depression (Alcohol Use Disorders Identification Test‐3 [AUDIT‐3] score of ≥3, Reynolds Adolescent Depression Scale‐2 [RADS‐2] score of ≥76). The Beck Hopelessness Scale (BHS) and Problem Oriented Screening Instrument for Teenagers (POSIT) were used to ascertain concurrent validity. Results: Sixteen percent (n = 48) of adolescents screened positive for elevated suicide risk. Within this group, 98% reported severe suicide ideation or a recent suicide attempt (46% attempt and ideation, 10% attempt only, 42% ideation only) and 27% reported alcohol abuse and depression. Nineteen percent of adolescents who screened positive presented for nonpsychiatric reasons. One‐third of adolescents with positive screens were not receiving any mental health or substance use treatment. Demonstrating concurrent validity, the BHS scores of adolescents with positive screens and the POSIT scores of those with positive screens due to alcohol abuse and depression indicated substantial impairment. The addition of alcohol abuse with co‐occurring depression as a positive screen criterion did not result in improved case identification. Among the subgroup screening positive due to depression plus alcohol abuse, all but one (>90%) also reported severe suicide ideation and/or a recent suicide attempt. This subgroup (approximately 17% of adolescents who screened positive) also reported significantly more impulsivity than other adolescents who screened positive. Conclusions: The suicide risk screen showed evidence of concurrent validity. It also demonstrated utility in identifying 1) adolescents at elevated risk for suicide who presented to the ED with unrelated medical concerns and 2) a subgroup of adolescents who may be at highly elevated risk for suicide due to the combination of depression, alcohol abuse, suicidality, and impulsivity.     

Effect of previous emergency psychiatric consultation on suicide re-attempts – A multi-center observational study

BackgroundThe emergency department (ED) is one of the first gateways when suicide attempt patients seek health care services. The purpose of this study was to analyze the hypothesis that people who received emergency psychiatric services in previous suicide attempts will have a lower mortality rate in current ED visits owing to subsequent suicide attempts.MethodThis retrospective study included patients who visited six EDs, and participated in the injury surveillance and in-depth suicide surveillance for 10 years, from January 2008 to December 2017. The study subjects were adult patients 18 years or older who visited EDs due to suicide attempts. The main explanatory variable is whether psychiatric treatment was provided in previous suicide attempts. The main outcome variable was suicide related mortality.ResultsThe study included 2144 suicide attempt patients with a previous history of suicide attempts. Among these, 1335 patients (62.2%) had received psychiatric treatment in previous suicide attempts. Mortality was significantly different between the psychiatric consultation group (n = 33, 2.5%) and non-consultation group (n = 47, 5.8%) (P < 0.01). In multivariate logistic regression analysis, previous psychiatric consultation showed a significant association with low mortality (adjusted OR 0.41; 95% CI [0.23–0.72]) and selecting non-fatal suicide methods (adjusted OR 0.47; 95% CI [0.36–0.61]).ConclusionPatients who received psychiatric consultation in previous suicide attempts had a lower suicide-related mortality in current ED visits as compared to patients who did not, and this may have been related to choosing non-fatal suicide methods.     

Interrelationships of Violence and Psychiatric Symptoms in Women with Substance Use Disorders

Women's issues of violence, mental health problems, and substance abuse have been noted to cooccur, but few studies have examined the interrelationship among the three. A chart review of 198 women (primarily African American) at an inner city substance abuse treatment center was performed to collect data related to physical and sexual abuse experiences before and after age 13. There were significant associations among all forms of physical and sexual abuse before and after age 13 and most of the types of substances abused and almost all of the presenting mental health problems, but most of the independent relationships became nonsignificant in multivariate analyses. However, the experience of both physical and sexual assault increased the risk of suicide attempts by a factor of 6.04. Physical assault was a borderline (p = .07) predictor of depression, while sedative use was significantly predictive of depression, anxiety, and suicide attempts.     

Ethnic,Gender, and Age Differences in Adolescent Nonfatal Suicidal Behaviors

This study examined ethnic differences in adolescent nonfatal suicidal behaviors as well as age and gender variation both across and within ethnic groups. Using a large (n = 14, 346) sample of adolescents in Grades 7 through 12, African Americans reported relatively high rates of suicidal thoughts and attempts and Southeast Asians reported high rates of suicidal thoughts. Hispanic Americans, European Americans, and Asian Americans were similar in their reports of nonfatal suicidal behaviors. Gender differences also varied across ethnicity as Southeast Asian boys (particularly older boys) reported more suicidal thoughts and attempts than Southeast Asian girls.     

The impact of physical or sexual abuse on chronic depression in adolescent mothers

This longitudinal investigation explored the impact of a childhood history of physical and sexual abuse on perinatal depressive symptomatology, suicide attempts, and maternal behavior in an ethnically diverse sample of 95 adolescent mothers. Maternal role attainment theory and the cognitive-interpersonal theory of depression provided the conceptual framework for this study. This investigation helps to expand theory on adolescent maternal role attainment by identifying a relationship between history of abuse, depressive symptoms over time, and maternal role behavior problems. Findings do not indicate that a history of childhood maltreatment alone increases a young mother's risk for maternal-child interaction problems.     

The relationship between abuse,sexually transmitted diseases, & group B streptococcus in childbearing women

PURPOSE: To examine the relationship between abuse, sexually transmitted diseases (STDs) and group B (GBS) infection among childbearing women using Selye's (1978) stress response theory. DESIGN AND METHODS: Retrospective chart review (n = 205) from two different clinical sites in Washington State, using the Childbearing Health Questionnaire to guide data collection. The women in the sample had an average age of 26.4 years and represented Anglo (81.4%), Hispanic (12%), Native American (3.9%), and African American (2.5%) ethnic groups. Thirty-eight percent ( = 78) reported experiencing physical and/or sexual abuse during their lifetimes and 31% had been diagnosed with an STD. RESULTS: Abuse was significantly related to STDs, and ethnicity emerged as a significant variable for the Hispanic women participating in this study. Findings indicated that infection with group B was also related to abuse status ( r=.60, p < or =.002) and to presence of herpes simplex virus-2 (r =.468, p相似文献   

Self-Injurious Behavior and Suicide Attempts Among Indonesian College Students

This study reports the prevalence of self-injurious behavior and suicide attempts among college students in Indonesia and examines risk factors distinguishing between 3 groups: self-injury with suicide attempt, non-suicidal self-injury, and non-self-injury. Self-report questionnaires measuring self-injury and suicide attempts, negative mood regulation expectancies (NMRE), depression, and childhood trauma were administered to 314 students. Of participants, 38% had deliberately injured themselves; among those, 21% also reported a suicide attempt. The 3 groups differed significantly on NMRE, depression, and child neglect. More self-injury and suicide attempts were associated with weaker NMRE and greater depression and child neglect.     

Cultural versus classic risk and protective factors for suicide

The current study examined the predictive value of cultural versus classic risk and protective factors for suicide in a community sample of 322 ethnic, sexual, and gender minority adults. Cultural factors played a significant and substantial role in predicting suicide attempts (explained 8% of variance in attempts and correctly classified 8.5% of attempters) over and above the classic factors of hopelessness, depression, and reason for living (which explained 17% of variance in attempts and correctly classified 14.1% of attempters). Findings suggest that cultural factors are important to include in standard suicide practice.     

Suicide in sexual minority populations: A systematic review of evidence-based studies

Sexual minority populations are exposed to more forms of distress than heterosexual individuals, thereby increasing the risk of suicidal behavior. It therefore seems surprising that suicidal behavior in sexual minorities is not sufficiently addressed in the nursing literature.The aim of this review was to integrate evidence-based knowledge and experiences related to suicide in sexual minorities into the nursing literature. This study has been conducted according to PRISMA guidelines, which contains a basic systematic screening process. Fourteen articles met the research criteria. The evaluation encompassed 4 themes: 1) Suicide attempts; 2) Thoughts of suicide; 3) Suicide attempts and completed suicide; 4) Suicidal thoughts and suicide attempts. Most studies focused on the dimensions of attempted suicide. The key finding was that young people in sexual minority groups exhibit more suicidal ideation, more suicide attempts and are more at risk of completed suicide than heterosexual individuals. Family-centered care for young people can therefore be one of the basic principles of nursing practice. Nurses can routinely ask adolescents about their sexual orientation and identity to provide appropriate assessment and care. Additionally, nurses can use educational, counseling, case manager and therapist roles to avoid negative experiences such as homophobia, stigmatization and the discrimination of sexual minorities.     

探究与大学生抑郁症自杀未遂行为相关的社会心理因素

目的:探究与大学生抑郁障碍患者自杀未遂行为相关的童年创伤、家庭功能及社会支持。方法:招募大学生抑郁障碍患者156例,根据既往是否存在自杀行为分为自杀未遂组(n=78)和非自杀未遂组(n=78)。采用儿童创伤问卷中文版(CTQ)、家庭功能量表(FAD)、社会支持量表(SSRS)对2组进行评估。结果:与非自杀未遂组相比,自杀未遂组的情感虐待(P0.001)、情感忽视(P=0.001)、性虐待(P=0.002)、躯体虐待(P0.001)、躯体忽视(P=0.001)因子评分及总分(P0.001)更高;角色(P=0.039)、情感介入(P=0.023)、家庭总功能(P=0.010)及总分(P=0.018)更高;主观支持(P=0.007)、支持利用率(P=0.005)因子评分及总分(P=0.011)更高。情感虐待、性虐待、支持利用率是导致自杀行为发生的独立危险和保护因素。结论:伴自杀未遂行为的大学生抑郁障碍患者存在更严重的童年创伤、更差的家庭功能以及更少的社会支持。     

Suicide risk among gay men and lesbians: A review

Without adequate death statistics from completed suicide data, the suicide risk for gay men and lesbians must be determined from empirical studies and from a theoretical understanding of suicide risk. Three large, well designed studies found that gay men and lesbians attempt suicide two to seven times more often than heterosexual comparison groups. Gay men and lesbians have significantly high rates of risk factors that increase suicide risk such as suicide attempts, alcohol abuse, drug abuse and interrupted social ties.

Durkheim suggests that groups with low social status and integration who are denied society's usual privilege and rights are at risk for alienation and anomic suicide unless protected by internal cohesion, religion or anlisuicide norms. Durkheim's theory applied to gay men and lesbians illustrates how the extensive and diverse alienation reported may lead to suicide. Diverse groups of gay people have not yet successfully decreased alienation or suicide.

Empirical evidence, risk factors and Durkheim's theory of anomic suicide thus supports the proposition that gay men and lesbians are at high risk for suicide. The need for sensitive research methodology, decreased heterosexual bias, creative network network sampling strategies, and confidentiality are discussed. Future research should clarify the completed suicide rates among diverse groups of homosexuals of different age, sex, race, and demographic variables.     

Context of sexual risk behaviour among abused ethnic minority adolescent women

CHAMPION J.D. (2011) Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58 , 61–67 Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14–18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self‐report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self‐reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported ‘getting high’ and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.